Clinical Gastroenterology and Hepatology. 2007 Nov;5(11):1306-12. Epub 2007 Aug 6.
Racial/ethnic differences in patient experiences with and preferences for computed tomography colonography and optical colonoscopy.
Rajapaksa RC, Macari M, Bini EJ.
Division of Gastroenterology, New York University School of Medicine, New York, New York, USA.
Significance:
Colorectal cancer (CRC) screening starting at the age of 50 years is recommended for all subjects at average-risk for CRC. However, racial/ethnic minorities are less likely to undergo CRC screening than white subjects.
CT Colonography (CTC) is a being promoted as a less invasive method of evaluating the colon and, therefore, may be more acceptable to racial/ethnic minorities. In a study of 272 subjects who had same-day CTC followed by optical colonoscopy, Dr. Bini and colleagues found that, contrary to their initial hypothesis, racial/ethnic minorities reported that optical colonoscopy was better tolerated and this test was preferred over CTC. These findings suggest that CTC is unlikely to overcome barriers to CRC screening among racial/ethnic minorities.
Abstract:
BACKGROUND & AIMS: Racial/ethnic minorities are less likely than whites to undergo colorectal cancer (CRC) screening. Although computed tomography colonography (CTC) is a less invasive alternative to optical colonoscopy (OC), it is not known whether CTC will increase acceptance of CRC screening in minorities.
METHODS: Patients undergoing OC for clinically indicated reasons had CTC followed by same-day OC. After the sedation from the OC had worn off, a questionnaire was administered to assess pain, discomfort, bloating, embarrassment, anxiety, and patient satisfaction using a 10-point scale (1 = least, 10 = greatest).
RESULTS: Of the 272 patients enrolled, there were 134 whites, 71 blacks, 53 Hispanics, and 14 who self-identified their race/ethnicity as other. Although the proportion of subjects who preferred CTC over OC was not significantly different (52.9% vs 47.1%, P = .36), racial/ethnic minorities were significantly less likely than whites to prefer CTC over OC (whites, 65.7%; blacks, 45.1%; Hispanics, 35.8%; and other, 35.7%; P < .001). Racial/ethnic minorities were less satisfied with CTC (whites, 8.4 +/- 1.7; blacks, 7.8 +/- 1.7; Hispanics, 7.4 +/- 1.8; and other, 7.5 +/- 2.1; P = .001) and were significantly less willing to undergo CTC again in the future (whites, 95.5%; blacks, 80.3%; Hispanics, 84.9%; and other, 85.7%; P = .006).
CONCLUSIONS: Compared with white patients, OC is better tolerated and is preferred over CTC for evaluation of the colon among racial/ethnic minorities. Although CTC is less invasive than OC, our findings suggest that CTC is unlikely to overcome racial/ethnic disparities in CRC screening.
PMID: 17689294
